What is the difference between internal and external hemorrhoids?
Medically reviewed by Dr. Robert William, MD · Written by Kevin Schwaner · Updated July 2026
Quick Answer
Internal hemorrhoids form above the dentate line, where there are few pain nerves, so they usually cause painless bleeding or prolapse and are graded I to IV by how much they protrude. External hemorrhoids form under the skin at the anal opening, are rich in nerves, and cause pain, itching, and swelling. Treatment differs: suppositories reach internal, creams treat external.
The dentate line divides the two. Above it, internal hemorrhoids sit in tissue with few pain-sensing nerves, so they typically announce themselves with painless bright-red bleeding or a sense of prolapse rather than pain. They are graded I to IV: Grade I bleeds without prolapse, II prolapses and retracts on its own, III must be pushed back manually, and IV stays prolapsed.
Below the dentate line, external hemorrhoids form under skin rich in nerve endings, so they hurt, itch, and can swell, and they can thrombose into a painful clot. The distinction guides treatment: suppositories deliver medicine to internal hemorrhoids, while creams and ointments treat external ones. Persistent bleeding from either should be evaluated.
120-day money-back guarantee · Made in an FDA-registered US facility
Sources
- NIH / NIDDK: Hemorrhoids
- ASCRS Clinical Practice Guidelines for the Management of Hemorrhoids
Related Questions
What is a thrombosed hemorrhoid? →How do you tell a hemorrhoid from an anal fissure? →When should you see a doctor for hemorrhoids? →*Informational only, not a substitute for professional medical advice. Any rectal bleeding should be evaluated by a doctor. These statements have not been evaluated by the FDA.